HomeMy WebLinkAboutMortgage_Money (2)�
�
�:�� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's' : FOR DEDUCTION FROM ASSESSED VALUATION n sh Year
'•. � «. / State Fwm 43709 (R6 / S-06)
� Presaibed by Department of Loral Gwemment Finance
% �i
INSTRUCTIONS: `-a-y/�� �
To be filed in person o� by mail wdh the County Auditor of the county where the property is located. �
Filing Dates: 1) Real Property: Dunng the 12 months before June 11 of the year the deduction is to t%���cf�feOUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be elfective.
See reverse side for additional instniclions and quali(ications.
Appliwnt (owner or ntract buye� - see restrictjpns on reverse side)
C
Taxing Distrid Key number / legal de ption Record number /� 7
a� -� 8' °Z7- 3�� ���' pa e number `,
�C"ir-c,v�v a y 3- 0 9 `1 �e4
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March i, current year March 1, wrtent year ownef7 ❑ Yes ❑ No
`(D 000
I( no, what is his / her exad share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horrie QC 61.1-�
e of mortgagee or conVact seller
� `-' ' —
Address of mortgagee or Vad seller (number and street, city, state, ZO -- __
r
i
Name of assignee or other awner or holder of mortgage D 1':1 �yCl' 1�� �, ,,/, ,� �� 4�,Li �
" r
...
• t
Address of assignee (num6er and street, city, state, ZIP code) � o �
C:lt'(� 1�'�. ........ �U �
, .....l...... ,
Dces applipnt own property in an other If es, what wun � / '
Y y ty. W��3�� � � requested on
county in Indiana? propetty ror aneu� yta� ? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20� 20� 20 20 20 20 20
� P
Signature County Auditor Date
We ceAity under the penalty of perjury that the above and foregoing intortnation is lrue and conect and that lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signatur (ow name) Person authorized by duly executed Power of Attomey
. or by IC 6-1.1-12-.07
Ful resident address of applipnt Address of authorized person
33 KZ ��j sa So f.13�,ncl. d.y7 �B